Reduce Claims To Improve WC Mod
December 2009
The workers compensation experience rating
plan is designed to either increase or decrease an employer’s workers compensation
insurance premium based on its own historical loss experience. The experience
rating plan gives employers the opportunity to help manage their own expense
and provides a method to tailor the cost of insurance to the individual characteristics
of an employer.
by David R. Ackerman, CRM, CPCU,
ARM, AU
Albert Risk
Management Consultants
The plan compares an insured’s workers compensation loss experience with
the loss experience of other insureds that have comparable operations and payroll
classifications, and establishes an individual experience rating modification
factor (a "mod").
In general, an employer with better-than-average loss experience receives
a credit mod (mod of less than 1.00) which reduces its premium. An employer
with worse-than-average loss experience receives a debit mod (mod of greater
than 1.00), which increases its premium.
Cost Control through Claims Management and Loss Prevention
The key to controlling costs is to improve loss experience, which
will improve the mod. There are several steps, including proactive accident
prevention and claims management, that can be taken to improve the mod:
- The mod is calculated based on payroll and loss data that insurers report
to the rating bureau. Reporting inaccurate or incomplete data can lead to
an incorrect mod. Obtain a copy of this mod worksheet and review the loss
and payroll data for accuracy.
- Establish a Safety Committee, create a safety program, and enforce the
rules. Set safety performance goals for supervisors and managers. Implement
a companywide reward program for reduced claim frequency. Offer incentives
to your employees for specified injury-free time periods or no lost time
injuries.
- Train each employee in the safety requirements of the job as well as
their responsibility for safety, and enforce compliance with these responsibilities.
Training should be ongoing. Frequently communicate the importance of safety
to employees.
- Take advantage of loss control and safety programs offered by your insurer
that deliver the best outcomes and cost savings.
- Maintain a clean work environment. Perform routine safety checks and
maintenance on all machinery and equipment. Implement a self-inspection
and accident investigation program.
- Perform job analysis. Determine job specifications, including any physical
requirements of the job. In the hiring process, follow these requirements
consistently to avoid claims of discrimination. Hire employees who are both
mentally and physically fit for the job.
- Maintain an alcohol and drug-free workplace. Use alcohol and drug testing
in the hiring process. In the case of an accident, require that the employees
involved be alcohol and drug tested. Conduct random alcohol and drug testing.
- Review loss runs for similar type claims, and work with your insurer’s
loss control department to make changes to your processes to reduce the
frequency of these claims. Pay close attention to tasks that seem to repeatedly
cause injuries, and change the nature of these tasks.
- Be alert to unhappy or disgruntled employees and deal with Human Resource
issues as soon as possible.
- Establish a working relationship with an experienced workers compensation
attorney who will provide prompt access to advice on workers compensation
issues that arise.
- Report all claims promptly to your insurer. Work with the insurer to
determine the fastest, most efficient way to report claims. Communicate
with insurers on all claims reported (no matter how small) and work with
them to provide prompt treatment.
- While all claims need to be reported to the insurer, consider obtaining
your insurer's permission to pay small (under $500) medical-only claims
out of pocket. The availability and impact will depend on your state and
your insurer, but this will help keep small losses out of your experience
rating. (Smaller claims paid out of pocket still need to be reported to
your insurance company.)
- Communicate to your employees the need to immediately report injuries
to their manager or supervisor. Train supervisors and managers on their
responsibilities when an injury occurs, on claim reporting procedures, on
how to communicate with injured employees, and how to help them obtain the
care and support they need.
- Implement an ongoing claims management program to manage outstanding
reserves and focus on efficiently closing open claims. Reserves vary depending
on the type of injury, seriousness, and duration of the claim. Review loss
information and challenge outstanding reserves that you feel are not reasonable.
Losses remain in the experience rating formula for 3 years, and open claims
need to be monitored.
- Rating bureaus typically use loss data valued as of 6 months prior to
the effective date of your mod. Review your loss runs on a regular basis,
and have your claims administrator establish periodic meetings with your
claims adjuster to review claims above a certain threshold, such as claims
greater than $5,000. At a minimum, have an annual claims review meeting
with your insurer before they submit your loss data the rating bureau.
- Routinely attend the conferences held on your cases at your division
of workers compensation.
- Depending on the state, the employer may have the right to choose the
doctor to treat workers compensation injuries. Before injuries occur, choose
a doctor who will be the first-line doctor for your business. Look for doctors
with occupational health experience as they understand treatment protocols
for work-related injuries and the benefits of returning the employee to
work. The right physician providing the right treatment at the right time
is essential to controlling costs.
- When possible, use one physician for all work-related injuries. Ask
the physician to come to your facility and learn about the nature of your
business, which will help him or her enhance the firm's return-to-work program.
- Build a referral network of preferred specialists to which your first-line
doctor can refer employees, if needed.
- Maintain positive communication with the employee and the doctor. Follow
all restrictions imposed by the physician on the employee. If the physician
has released the employee to return to light duty, find a place for the
employee in your workforce.
- Assign an injury management coordinator who will keep everyone involved
with the claim (such as the employee, doctor, claims adjuster, and employer)
informed and moving in the right direction.
- Implement a return-to-work program that is appropriate for the scope
of the injured employee. Provide transitional duty programs that help injured
employees return to a productive position as soon as medically approved.
Implement a light-duty program for injured workers to be able to return
to the workplace quickly.
- If an employee is injured by a third party, make sure your insurer is
subrogating the claim against the third party, which will reduce the amount
of your workers compensation claim.
Conclusion
Improving your loss experience will improve your experience modification
factor which will reduce your premiums. An improved mod may make your operations
appealing to more underwriters, may provide you with rate deviations or loss
sensitive rating plans that may not otherwise have been available to you; and
overall will reduce your costs of doing business.
*The
Albert Risk
Management Consultants claims management team (Glenn Brown, Lisa Hartman,
William Quinn, Jr., David Ackerman, and David A. Tweedy) contributes articles
on claims topics. You can reach David Ackerman at
.
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